Much Ado About 5010

We’re seeing a lot of talk about 5010 as the end of the year approaches. Curious to learn more, we took it to our resident experts, Kayla Milburn and Paul Schwartz, for all the answers.

Lindsay: Kayla and Paul, thanks for taking time today to tell us about 5010. Can you tell me what physical therapists should know about 5010?

Paul: Not much. This change is really important for insurance companies and billing companies. Any physical therapist that uses an in-house software such as Kareo, or outsources their billing doesn’t have much to worry about. CMS has more resources and AMA has a toolkit to get started with 5010.

“Practices that conduct one or more of the HIPAA transactions electronically, such as submitting a claim or checking a patient’s eligibility, or rely on a billing service or clearinghouse to do this on their behalf, are affected by this change.” - American Medical Association

Lindsay: Can you tell me what is changing from 4010 to 5010 for the insurance and billing companies?

Kayla: Some of the field requirements are changing, such as the zip code. Now, billing companies will need to have a nine (9) digit zip code for each service location. Another change is that the billing provider address can no longer be a PO Box. Other aspects like formatting have been changed to be more clear and more efficient.

Lindsay: We heard just last week that CMS created a grace period until March 31st. What does that mean?

Paul: It means that some insurance companies will still be using the 4010 Version while some others will have already made the switch. Again, this is really only for insurance companies and billing companies. They will have to manage the different templates.

And that’s all she wrote, folks! For those interested in even more resources, check out GetReady5010, a site that provides educational webinars on the topic.

Image thanks to the San Francisco Medical Society Blog